Fema Form 086-0-33 - Elevation Certificate - U.s. Department Of Homeland Security
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6U.S. DEPARTMENT OF HOMELAND SECURITY
OMB No. 1660-0008
Federal Emergency Management Agency
Expiration Date: November 30, 2018
National Flood Insurance Program
ELEVATION CERTIFICATE
Important: Follow the instructions on pages 1–9.
Copy all pages of this Elevation Certificate and all attachments for (1) community official, (2) insurance agent/company, and (3) building owner.
SECTION A – PROPERTY INFORMATION
FOR INSURANCE COMPANY USE
A1. Building Owner's Name
Policy Number:
A2. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and
Company NAIC Number:
Box No.
City
State
ZIP Code
A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.)
A4. Building Use (e.g., Residential, Non-Residential, Addition, Accessory, etc.)
A5. Latitude/Longitude: Lat.
Long.
Horizontal Datum:
NAD 1927
NAD 1983
A6. Attach at least 2 photographs of the building if the Certificate is being used to obtain flood insurance.
A7. Building Diagram Number
A8. For a building with a crawlspace or enclosure(s):
a) Square footage of crawlspace or enclosure(s)
sq ft
b) Number of permanent flood openings in the crawlspace or enclosure(s) within 1.0 foot above adjacent grade
c) Total net area of flood openings in A8.b
sq in
d) Engineered flood openings?
Yes
No
A9. For a building with an attached garage:
sq ft
a) Square footage of attached garage
b) Number of permanent flood openings in the attached garage within 1.0 foot above adjacent grade
c) Total net area of flood openings in A9.b
sq in
d) Engineered flood openings?
Yes
No
FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
SECTION B –
B1. NFIP Community Name & Community Number
B2. County Name
B3. State
B4. Map/Panel
B5. Suffix
B6. FIRM Index
B7. FIRM Panel
B8. Flood
B9. Base Flood Elevation(s)
Number
Date
Effective/
Zone(s)
(Zone AO, use Base Flood Depth)
Revised Date
B10. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in Item B9:
Other/ Source:
FIS Profile
FIRM
Community Determined
NGVD 1929
NAVD 1988
Other/
B11. Indicate elevation datum used for BFE in Item B9:
Source:
B12. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)?
Yes
No
Designation Date:
CBRS
OPA
FEMA Form 086-0-33 (7/15)
Replaces all previous editions.
Form Page 1 of 6
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